Provider Demographics
NPI:1750931754
Name:GAVINELLI, MARIA (MS CCC-SLP, TSSLD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:GAVINELLI
Suffix:
Gender:F
Credentials:MS CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BAYSIDE LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-3908
Mailing Address - Country:US
Mailing Address - Phone:646-734-3478
Mailing Address - Fax:
Practice Address - Street 1:15 HEDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-2204
Practice Address - Country:US
Practice Address - Phone:646-734-3478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-12
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist